| Name | Value |
|---|---|
| PROVIDER TYPE | Dental Providers |
| CLASSIFICATION | Dentist |
| DEFINITION | That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| AREA OF SPECIALIZATION | Periodontics |
| STATUS | Active |
| VA CODE | V030507 |
| X12 CODE | 1223P0300X |
| SPECIALTY CODE | C5 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252489 |
| EFFECTIVE DATE/TIME |
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